NPIMap

Organization Active NPI

North Shore Long Island Jewish Healthcare Inc.

  • Gynecologic Oncology Physician
  • Brightwaters, NY
National Provider Identifier
1710345962
Registry record updated Feb 23, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gynecologic Oncology PhysicianTaxonomy code 207VX0201X
Legal business name
NORTH SHORE LONG ISLAND JEWISH HEALTHCARE INC.
Practice address
404 Potter Blvd
Brightwaters, NY 11718-1830
Phone
(631) 376-0055
NPI assigned
Feb 3, 2016
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 23, 2016

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Robert S Shapiro
Title
Executive VP & Cfo
Phone
(516) 465-8162

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Gynecologic Oncology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207VX0201X Primary

Addresses

Primary practice location

404 Potter Blvd
Brightwaters, NY 11718-1830

Mailing address

404 Potter Blvd
Brightwaters, NY 11718-1830

Other names 1

  • Island Gynecologic Oncology Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20070215000718 NY Part B Supplier - Clinic/Group Practice 3971531039 Receives reassigned benefits from 219 practitioners
6 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment

Other NPIs on the same Medicare enrollment 6

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory

Locations

404 Potter Blvd
Brightwaters, NY 11718
Phone (631) 376-0055

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1454457600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1456185600000",
    "number": "1710345962",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "404 POTTER BLVD",
            "city": "BRIGHTWATERS",
            "state": "NY",
            "postal_code": "117181830"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "404 POTTER BLVD",
            "city": "BRIGHTWATERS",
            "state": "NY",
            "postal_code": "117181830",
            "telephone_number": "631-376-0055"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTH SHORE LONG ISLAND JEWISH HEALTHCARE INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-02-03",
        "last_updated": "2016-02-23",
        "status": "A",
        "authorized_official_last_name": "SHAPIRO",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "EXECUTIVE VP & CFO",
        "authorized_official_telephone_number": "516-465-8162",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "207VX0201X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Obstetrics & Gynecology, Gynecologic Oncology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Island Gynecologic Oncology",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Brightwaters, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 23, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.